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Dhaka, Bangladesh

HIV/AIDS/STI Prevention

Dhaka, Bangladesh

Kathmandu Valley, Nepal

Analysis of Family Planning / HIV/AIDS Integration Activities within the USAID Population, Health and Nutrition Center
- by ww.advanceafrica.org

USAID's National Integrated Population and Health Programs

USAID/Dhaka is one of the largest donors to the HIV/AIDS sector. Technical assistance and support have included a social marketing program, peer education, condom promotion and sexually transmitted infection (STI) prevention and care services targeted towards high-risk populations, as well as information, education, communication (IEC) activities and surveillance/operations research. USAID's National Integrated Population and Health Programs (NIPHP) deliver essential service packages, including family planning, communicable disease control, behavior change communication and reproductive health interventions for men, women and adolescents in both rural and urban Bangladesh. These essential service package activities are carried out by 46 local NGOs, operating in about one-third of Bangladesh's counties, with catchments of approximately 17% of the population.

The NIPHP also includes an HIV/AIDS prevention component. The Mission's HIV/AIDS prevention strategy has been revamped to de-emphasize reproductive health activities targeted primarily at the general population to focus instead on more specific groups at high risk for HIV infection, such as commercial sex workers, clients of sex workers and men who have sex with men. The urban service delivery program has expanded efforts to provide STI treatment in area clinics where the at-risk groups are located.

In its third year of operation, NIPHP's 322 NGO clinics, 10,335 associated satellite clinics and more than 9,300 depot holders (rural women providing contraceptives and oral rehydration [ORS] in their homes), attracted 65,000 more clients than in the previous year. Distribution of oral contraceptives, injectables and condoms rose 53%, 7% and 50%, respectively, in combined rural and urban sites in Bangladesh. In addition to the government program, several NGOs have established clinics for adolescents, although attendance is reported to be low.

In accordance with UNAIDS guidelines, the AIDS and STD Control Program has concentrated HIV surveillance efforts on high-risk occupational groups. The most recent HIV prevalence rate in Bangladesh for adults aged 15-49 is estimated to be at a low rate of 0.02%. A total of 13,000 HIV cases nationwide are estimated according to the statistics published by UNAIDS in 2000, of which 1,100 or 8.5% are women and 11,900 or 91.5% are men. However, higher rates have been reported in individual studies of particular population subgroups.

USAID/Dhaka is one of the largest donors to the HIV/AIDS sector.  Technical assistance and support have included a social marketing program, peer education, condom promotion and sexually transmitted infection (STI) prevention and care services targeted towards high-risk populations, as well as information, education, communication (IEC) activities and surveillance/operations research. USAID's National Integrated Population and Health Programs (NIPHP) deliver essential service packages, including family planning, communicable disease control, behavior change communication and reproductive health interventions for men, women and adolescents in both rural and urban Bangladesh.  These essential service package activities are carried out by 46 local NGOs, operating in about one-third of Bangladesh's counties, with catchments of approximately 17% of the population. 

The NIPHP also includes an HIV/AIDS prevention component.  The Mission's HIV/AIDS prevention strategy has been revamped to de-emphasize reproductive health activities targeted primarily at the general population to focus instead on more specific groups at high risk for HIV infection, such as commercial sex workers, clients of sex workers and men who have sex with men.  The urban service delivery program has  expanded efforts to provide STI treatment in area clinics where the at-risk groups are located.

In its third year of operation, NIPHP's 322 NGO clinics, 10,335 associated satellite clinics and more than 9,300 depot holders (rural women providing contraceptives and oral rehydration [ORS] in their homes), attracted 65,000 more clients than the previous year.  Distribution of oral contraceptives, injectables and condoms rose 53%, 7% and 50%, respectively, in combined rural and urban sites in Bangladesh.  In addition to the government program, several NGOs have established clinics for adolescents, although attendance is reported to be low.

In accordance with UNAIDS guidelines, the AIDS and STD Control Program has concentrated HIV surveillance efforts on high-risk occupational groups.  The most recent HIV prevalence rate in Bangladesh for adults aged 15-49 is estimated to be at a low rate of 0.02%.  A total of 13,000 HIV cases nationwide are estimated, according to the statistics published by UNAIDS in 2000, of which 1,100 or 8.5% are women and 11,900 or 91.5% are men.  However, higher rates have been reported in individual studies of particular population subgroups.

CATALYST Country Background Paper

To better inform the research framework, sampling and instruments for the qualitative formative research study on HIV/AIDS/STI and young men, CATALYST staff prepared a Country Background Paper.  The paper analyzes and presents the latest HIV/AIDS/STI epidemiological and behavioral survey data, as well as information on sexual and reproductive health interventions undertaken in recent years with young men in Bangladesh.

Epidemiological Data on HIV/AIDS Prevalence among High-risk Groups

Surveillance systems in Bangladesh have reported limited spread of HIV/AIDS, and national prevalence rates are currently at a low rate of 0.02% for adults aged 15-49.  There is no guarantee, however, that the rate will remain low.  Bangladesh shares borders with India and Burma, countries where HIV/AIDS prevalence rates are much higher.  Multiple factors suggest a potential risk of HIV spreading in Bangladesh, including: a thriving sex industry with male, female and transgendered sex workers and a diverse clientele; the low status of women; very high rates of reported STIs; reports of high prevalence of male-to-male sexual behaviors; very poor knowledge of HIV and risk perception; low condom use; poor health-care seeking behaviors; injection drug use; and an unsafe blood supply.

Studies conducted by the Naz Foundation International in Bangladesh have reported that the numbers of men engaging in sexual relationships and behaviors with other men are significant.  Further, the studies show that the male-to-male sexual behavior occurs across the spectrum of age, socioeconomic class and occupation.  In a qualitative sexual and reproductive health study, adolescent boys in three rural and two urban samples of Bangladeshi youth reported M-M behaviors, including anal sex.  The boys also reported M-M sexual behavior between adolescent boys and older men.  Research from around the world has indicated that for many young men, engaging in sexual activities with another man is a common part of sexual experimentation.

Reaching young men early with effective sexual and reproductive health information and interventions is therefore vitally important in preventing the growth and spread of HIV/AIDS/STIs in Bangladesh.  Programs inculcating motivations for behavior-the manner in which young men perceive themselves as being responsible for their own sexual and reproductive health and the processes by which they establish healthy sexual and reproductive behaviors-are likely to have a greater impact than programs restricting themselves solely to established behaviors, such as consistent condom use, abstinence or mutual fidelity.  To have the greatest potential impact, the manner in which social and normative patterns of sexual and reproductive health attitudes and behavior are influenced and formed in young men from early adolescence on must be explored.

CATALYST-funded Research

HIV/AIDS/STI programs that are based on formative data about why some young men behave the way they do can maximize their impact on behavior.  Despite this, existing research on adolescent boys and their sexual and reproductive health is largely focused on knowledge, attitudes and practices, but not on the determinants of behavior that would positively affect health.  There is a clear need for reaching young adolescent males with sexual and reproductive health information and interventions before they become sexually active-ideally beginning in their early formative years.  At that stage of their growth, they can be more effectively influenced to understand and make use of safe sexual practices, including delaying sex and using condoms.

A study underway in Dhaka, Bangladesh, conducted by the Bandhu Social Welfare Society, Naz Foundation International and the CATALYST Consortium, is studying this topic on three levels:  a) the individual (the actor's attitudes and emotions); b) the interactional (how identified socialization agents impact the sexual scripting and thinking of young men); and c) the cultural (gender roles and expectations). 

Additional research data are needed to gain more insights into how young mens' normative patterns of sexual attitudes and behavior are influenced from their early pre-adolescent years.  These data will help in understanding the images young men create about their own masculinity and sexuality, the sexuality of other young men and the sexuality of young women.  The data will also provide insight into what impact these images have on young men's own risk behaviors, what meaning they give to them and how these images reinforce their actions.

This report will generate qualitative behavioral data that defines the processes by which young men develop normative patterns of sexual and reproductive health behavior, and the socialization agents that influence these behaviors.  The data will assist the USAID Mission in addressing HIV/AIDS/STI issues and developing appropriate and effective interventions for young men, including adolescents.  The objective of the research funded in Bangladesh is to provide information that addresses the following issues:  a) delaying sexual activity; b) developing greater respect and sensitivity towards girls and women; c) understanding and practicing safer sex (particularly condom use); and d) using family planning and reproductive health services.

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